Grand Canyon University: NRS-427V
11/23/13

“In 1895 varicella infection (chickenpox) was not reliably distinguished from smallpox until the end of the 19th century. The first vaccine to reduce the risk of herpes zoster was licensed in May 2006.” (Center for Disease Control and Prevention, 2013)
Chickenpox is a highly infectious childhood disease. Varicella zoster virus causes chickenpox, and also shingles. When infected with chickenpox the most well-known symptom are the skin lesions present that appear on the torso then spreading to the rest of the body in rapidly, can take a couple of hours. The skin lesions that are present occur in the stages of macule, vesicle, and granular scabs, the size varies from one to four mm. It only takes a few hours for the first step, macule lesions to spread from the torso which is where the most of the fluid filled vesicles are seen, then to the rest of the body such as the mucous membranes, arms, legs, mouth, head, upper respiratory tract, vaginal/penis areas, and even the conjunctivae/ cornea. The vesicle stage of chickenpox happens when the lesions which resemble blisters can appear raised or depressed in appearance, and the third stage occurs when the blisters open, then dry and become scabs. Approximately by the third day of having chickenpox it is common to see all three of the different stages of vesicles at the same time. The skin lesions commonly two hundred to five hundred are referred to as one crop, with chicken pox there are approximately two to four crops during the illness. Chickenpox also occurs with moderate to intense pruritus due to the fluid filled vesicles throughout the skin surface.
The symptoms that may occur with chicken pox are, a low grade fever, up to 102 degrees on average that typically begins a few days before the skin vesicles for adults which can be treated with Tylenol, generalized ill feeling, pruritus can be treated with warm oatmeal baths and/or Benadryl, decreased appetite, coughing, and observed in younger children a fussy temperament and low grade fevers usually occur after the characteristic vesicles appear. Drinking plenty of fluids is also imperative to maintain hydration.
“The components of the immune system involved in innate immunity-including macrophages, neutrophils, and complement- recognize a wide range of foreign antigens. Adaptive immunity, on the other hand, is specific to the particular antigen encountered. Because of the adaptive immunity, the immune system can remember a previously encountered antigen and respond in a quick and vigorous way. This memory is carried by lymphocytes, which are long-lived cells. This immune response is why people generally have infectious diseases like chickenpox and measles only once, and it is also responsible for success of vaccinations in preventing disease. Dwindling of immune memory over time accounts for the later development of herpes zoster (shingles) many years after a chicken pox infection.” (Copstead-Kirkhorn, 2010)
After successful recovery of chickenpox the results are immunity of virus reoccurrence for majority of the population due to the presence of titers now active within the immune system. Reoccurrence of the virus does not happen often but it is possible, it is more common for the immunocompromised population such as human immunodeficiency virus, lymphoma, and leukemia for example than the relatively healthy counterparts. Children under the age of one, and over the age of fifteen otherwise known as adults tend to have an increased percentage rate of complications associated with the virus known as chickenpox.
“In the prevaccine era, approximately 11,000 persons with varicella required hospitalization each year. Hospitalization rates were approximately 2-3 per 1,000 cases among healthy children and 8 per 1,000 cases among adults. Death occurred in approximately 1 in 60,000 cases. From 1990 through 1996, an average of 103 deaths from varicella were reported each year. Most deaths occur in immunocompetent children and adults. Since 1996, the number of hospitalizations and deaths from varicella had declined more than 90%.” (Center for Disease Control and Prevention, 2013)
Growing up as a child before a vaccination was available for Varicella zoster virus, getting the virus was a common event and a rite of passage as a child. Often times if one child got the chickenpox parents would have a “chickenpox parties”, due to the virus being highly contagious, the purpose of this was to have all the neighborhood kids come over to play with the infected child so other children would then also contract the chickenpox to in a since get it over with. “Varicella-zoster immune globulin provides passive immunity against chickenpox and is recommended after exposure, especially for high-risk groups. A vaccine against chickenpox that will provide active immunity is also available. Vaccination is currently recommended for all children and sometimes requited for school entrance.” (Copestead-Kirkhorn, 2010) Chicken pox outbreaks occur the most often within the school setting such as middle school through the college setting due to the virus being highly contagious. Requiring students of all ages to either get the vaccination or have titers drawn has decreased the odds of having outbreaks. Healthy people 2020 have an objective to reduce, eliminate, or maintain elimination of vaccine-preventable disease. The targeted goal for healthy people 2020 is 100,000 which is a significant decrease from the published 2008 reports of 582,535. The recommended vaccination for chickenpox is a two-step process. The first vaccination ideally should occur at twelve to fifteen months of age, and the second vaccination should occur between the ages of four and six. Titers for chicken pox can be measured in a blood draw, if the titer results are low then another single dose vaccination can be administered to gain a higher amount of titers.
The contribution of the determinants of health may depend on several different things around the individual that is infected by the varicella virus. “Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income, and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. (World Health Organization, 2013)
The epidemiologic triangle represents a balance of health if there are any changes to an aspect of the triangle, as a result the overall balance of health and wellness has the opportunity to change the outcome of illness. The three sides of the epidemiologic triangle represent the individual as a person, what the illness is, and the environment. “For the person or host, demographic characteristics, the level of health and history of prior disease, genetic predisposition, states of immunity, body defenses, and human behavior should be examined. Causative agents may include biologic, physical, chemical, nutritional, genetic, or psychological factors that have the ability to affect health and disease in the person. The environment includes anything external to the person or agent, including the presence of other persons or animals that potentially affect health and disease. (Smith, 2009)

The nurse within the community health is responsible to report certain test results/diagnosis to the respective authorities. “As a first step in establishing national varicella surveillance, varicella deaths became nationally notifiable in 1999. In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that states being reporting individual cases of varicella by 2003 and implement state-wide case-based reporting by 2005. The three initial core variables recommended by CDC for case-based reporting included age, vaccination status, and severity of disease (based on number of lesions). However, states conducting case-based surveillance should now be collecting demographic, clinical, and epidemiologic data on each case. States unable to collect these data should collect, at a minimum, the three key variables mentioned above. It is also important to collect information on the case outcome (i.e., whether the patient was hospitalized or died). Probable and confirmed cases of varicella should be reported to CDC.” (Center for Disease Control and Prevention, 2008)
Upon completing research to write this epidemiology paper I was unsuccessful in locating a national agency or organization that addressed chicken pox/varicella virus, when searching for information there are many website’s that review the signs and symptoms, treatment, and vaccination procedures but no other pertinent information was located. The vaccination appears to have been a success.

References
Copstead-Kirkhorn. Pathophysiology, 4th Edition. W.B. Saunders Company, 2010.
Center for Disease Control and Prevention. (2012). Varicella Epidemiology and Prevention of Vaccine-Preventable Diseases. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html
Center for Disease Control and Prevention. (2008). Strategies for the Control and Investigation of Varicella Outbreaks Manual. Retrieved from http://www.cdc.gov/chickenpox/outbreaks/manual.html
World Health Organization. (2013). Health Impact Assessment The Determinants of Health. Retrieved from http://www.who.int/hia/evidence/doh/en/
Smith, Maurer a. Community/Public Health Nursing Practice: Health for Families and Populations, 4th Edition. W.B. Saunders Company, 2009.